Hi Doctor, Three years ago I began a fairy-tale love affair with a prominant Muslim woman from the Middle East. We tried to avoid falling in love but that's inpossible when it is the real thing. There were complexities with us due to several reasons regarding culture and societal expectations but we made plans to continue our relationship work after grad school and our careers in Public Service began. We simply became inseperable, as if we were one person. We had simply believed that we were soulmates and gave into our desire for the love we gave each other. Two years ago I tested positive after being looked over thinking I had cancer. It was a real shock. A few months after she was clear, she went away for the summer and when she returned she ended our relationship. I fully accepted her decision. I was really moving on in a healthy way and satisfied with knowing our love was real. Evne so, my mental health sort of deteriorated shortly after. I lost sefl-confidence and esteem, had guilt and shames over losing her, and went nearly insane trying to account for contrating hiv. Then, several months later, she came to me vowing she didn't want to live without me in her life. We picked up where we left off but I was so distracted by the hiv and doctors and so on, things indeed had changed a bit. Last summer she went abroad and when she returned, on our first night together, she told me, "No more relationship, no feelings, no emotions, no love". Since then I have fallen to hell with bitterness, anger, feeling betrayed and abandoned. She got involved with another and refused to even take my calls or talk to me; wouldn't even say "hi" to me when we corssed patsh on campus or in town. Again, one day, she called me and we spent a week making love as if we never stopped. Only, one night, the condom slipped off of me and lodged inside of her. We don't know how long she was exposed but it was probably more tha a half hour during one of our marathons. I almost never ejaculate and didn't that night. The next afternoon we met with my ID doctor and she went on PEP, had miserable side effects, but finally tested negative. During this month I realized how much I was afraid of infecting her, I relived the initial horror that I experienced shortly after my testing positive. She experienced ups and downs too. I decided I needed to seperate from her to avoid infecting her as our sex together is full of loving passion and goes all nigt, but at times it's hard and wild beyond ordinary consciousness. I couldn't seperate from her easily, I got a little ugly and she again grew distant, angry, then seemed to have lost respect for me, and completely cut off communincation with me. In a way, I purposefully angered her with my not so purposeful irrational behaviour. I really wanted her to be angry with me so she wouldn't carry guilt, regarding me/us, in any way, and I also wanted to make sure she wouldn't come back to me as it appeared she had this pattern of behaviour which drove me quite to batty. I fear I have achieved my intended goals and now I reget it so very damned much, I have been depressed, and so sad about it. I've tried therapy but it doesn't seem to work. The therapists don't treat me as I feel they should, telling me the HIV is my problem, not the relationship. I guess they don't believe that a real princess falls in love with ordinary men like myself. They say forget her, but when you reach middle age and fall in love as we did, then the most unreasonable circumstances sets you apart adn you willfully end a end it as I did, in order to protect her from getting hiv, well... I'm having a difficult timne living with myself now, and there's absolutely no way I would allow myself to live if I infected her. I'm wondering if you've heard of similar incidents with others who've turned positive during a realationship and what should I do? There's one small support group locally but it's all gay me, very nice men, but with a different attitude than me. I feel so empty, so devoid of hope, and no desire to think about the fuiture. My plans have changed and I'm sort of drifting out to sea. ANy suggestions?
Thank You in advance.

Response from Dr. Remien

Clearly you and this woman have had a very difficult time coping with the news of your HIV infection and have both been ambivalent about wanting to commit to the relationship and try to work things out. You are not alone in having a lot of anxiety about the possible transmission of HIV in a loving relationship. It does sometimes happen that HIV is transmitted in such relationships. The ability of a couple to be able to deal with that usually depends on the strength of the relationship that is there before it happens. While HIV transmission in a relationship is a serious thing and couples need to do everything they can to try to prevent this, if and when it does happen, it is not the end of the world.

It sounds to me like you have done the things that would be recommended to you, including consulting with medical professionals, seeking therapy, and going to a support group. It also sounds to me like you are suffering from depression, although I am not able to definitively diagnose this simply from what you have told me and not seeing you. I would recommend that you continue to speak with a mental health professional - either the one you know, or seek another if you are not comfortable with this person. And depression should be evaluated and treated, if diagnosed. Please get the help that you need for yourself. Take care.

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